Question

Scenario

You are the nurse working triage in the emergency department (ED). This afternoon a woman brings in her father, ALI, a 72-year-old who is a retired doctor. The daughter reports that over the past several months she has noticed her father has progressively had problems with his mental capacity. These changes have developed gradually but seem to be getting worse. At times he is alert, and at other times he seems disoriented, depressed, and tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and sugar in the refrigerator. He had difficulty finding objects in the kitchen and at times forgets where his room is.

This morning he thought it was nighttime and wondered what his daughter was doing at his house. He could not pour his coffee, and he seems to be getting more agitated. ALI reports that he has been having memory problems for the past year and at times has difficulty remembering the names of family members and friends.

A review of his past medical history (PMH) is significant for hypercholesterolemia and coronary artery disease (CAD). He had a myocardial infarction (MI) 5 years ago. ALI’s vital signs (VS) today are all within normal limits (WNL).

Q:You understand that other disorders may have presentations similar to dementia. Name one and discuss it.                                 

Answer 1

PARKINSONS DISEASE

Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

Symptoms

Parkinson's disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides.

Parkinson's signs and symptoms may include:

• Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may a rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest.
• Slowed movement (bradykinesia). Over time, Parkinson's disease may slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk.
• Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion.
• Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson's disease.
• Loss of automatic movements. You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
• Speech changes. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
• Writing changes. It may become hard to write, and your writing may appear small.

• Risk factors

  Risk factors for Parkinson's disease include:

• Age. Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older.
• Heredity. Having a close relative with Parkinson's disease increases the chances that you'll develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease.
• Sex. Men are more likely to develop Parkinson's disease than are women.
• Exposure to toxins. Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson's disease.

• Complications

• Thinking difficulties. You may experience cognitive problems (dementia) and thinking difficulties. These usually occur in the later stages of Parkinson's disease. Such cognitive problems aren't very responsive to medications.

• Depression and emotional changes. You may experience depression, sometimes in the very early stages. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson's disease.

  You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms.

• Swallowing problems. You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling.
• Chewing and eating problems. Late-stage Parkinson's disease affects the muscles in your mouth, making chewing difficult. This can lead to choking and poor nutrition.

• Sleep problems and sleep disorders. People with Parkinson's disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day.

  People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may help your sleep problems.

• Bladder problems. Parkinson's disease may cause bladder problems, including being unable to control urine or having difficulty urinating.
• Constipation. Many people with Parkinson's disease develop constipation, mainly due to a slower digestive tract.

Medications

Carbidopa-levodopa.

Carbidopa-levodopa infusion.

Dopamine agonists

Catechol O-methyltransferase (COMT) inhibitors.

Anticholinergics

Amantadine